The Effect of High Heel Shoes on Tibiofemoral and Patellofemoral joint Contact Forces and Muscle Forces

Introduction: High heel shoes affect the knee joint and can cause arthritis in the tibiofemoral (TFJ) and patellofemoral joints (PFJ). There is a dearth of research investigating the contact forces of TFJ and PFJ. Therefore, the purpose of this study was to assess the effect of high heel shoes on muscle forces as well as TFJ, and PFJ contact forces during walking.   Materials & Methods: A total of nine young females with mean age, height, and body mass of 21.34±3.83 years, 1.49±0.14 m, and 60.54±1.76 kg, respectively, were randomly included in this study. The walking variables in each case were measured while walking with 6-cm-heels, 3-cm-heels, and without shoes. All measurements were conducted on the right legs. The Qualisys motion analyzer and Kistler Force Plate were utilized to record data. The data were collected using OpenSim software to obtain muscular and joint contact forces. In addition, the data were analyzed in SPSS software. P-value less than 0.05 was considered statistically significant.   Findings: The internal and external TFJ contact force during walking with 6-cm-heels was 3.66±4.07 N/BW, which was significantly higher than that during walking without shoes (P=0.05). The anterior-posterior PFJ contact force was obtained at 1.71±0.27N/BW, which was significantly greater than that during walking without shoes by 0.61 N/BW (P=0.001). Moreover, the vertical force of PFJ contact forces during walking with 6-cm-heels (6 cm) was significantly greater than that during walking without shoes (P=0.025). However, there were no significant differences between walking with 6- and 3-cm-heels regarding anterior-posterior, internal-external, and vertical TFJ and PFJ forces (P>0.05).   Discussion & Conclusions: Walking with high heel shoes increased joint contact force in the medial compartment of TFJ and PFJ during the stance phase of the gait cycle. This increase in forces as cumulative forces can put the joint at the high risk of degeneration and arthritis. The TFJ and PFJ pain are warning signs of walking with high heel shoes. Given the harmful effect of high heels on TFJ and PFJ, it is recommended to use low heel shoes or flat ones.